In a multi-center randomized, clinical trial, patients who underwent a laparoscopic colectomy for colon cancer were found to have noninferior oncologic results when compared to patients who underwent an open colectomy for colon cancer. Oncologic outcomes was defined as the rate of colon cancer recurrence. At 3 years followup, 16% of the laparoscopically treated patients had a recurrence; 18% of the patients treated with open surgery had a colon cancer recurrence. Secondary outcomes documented a shorter length of stay in the laparoscopic-surgery group when compared with the open-surgery group (five days vs. six days, P<0.001) and briefer use of parenteral narcotic (three days vs. four days, P<0.001) and oral analgesics (one day vs. two days, P<0.001). The rates of intraoperative complications, 30-day postoperative mortality, complications at discharge and 60 days, hospital readmission, and reoperation were very similar between groups.

Commentary

Summary of conclusions: Laparoscopic colectomy for colon cancer results in equivalent cancer outcomes when compared to open colectomy, but results in a quicker recovery.

This study is sometimes referred to as the COST trial for the authors: Clinical Outcomes of Surgical Therapy (COST) Study Group, which is a fairly large group of surgeons. The lead author and the Principal Investigator of the study is Heidi Nelson, a colorectal surgeon at the Mayo Clinic. The members of the writing committee of the COST Study Group are listed in the left margin of the first page of the manuscript.

Sample size: about 430 surgeries of each type, spread across more than 40 institutions.

Before this paper, there was considerable doubt whether cancer of the colon could be treated well by laparoscopic surgery. Most surgeons would not do a laparoscopic colectomy for colon cancer because of fear that it was inferior treatment. This was a seminal paper in changing that attitude. Other randomized trials have mostly confirmed these results. Still in 2014, most colon surgery for cancer is not done laparoscopically because of technical challenges.